Obtaining Blood Specimens from a Central Venous Catheter



|Obtaining Blood Specimens from a Central Venous Catheter H5MAPR0205 |Level III |

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|Purpose |The purpose of this procedure is to provide guidelines for the safe and aseptic sampling of the resident’s blood |

| |from a central venous catheter. |

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|Preparation |A physician order is required to obtain blood samples. |

| |Verify in state Nurse Practice Act regarding scope of practice for this procedure. |

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|General Guidelines |All four categories of central catheters (tunneled, non-tunneled, implanted port, PICC) can be used to draw blood.|

| |Needleless connection devices should be flushed with normal saline (preservative-free 0.9% normal saline) pre/post|

| |blood withdrawal.[1] |

| |Refer to facility policy for the amount of flush that is used before and after blood sampling. |

| |For multi-lumen devices use the largest lumen available to draw blood. |

| |Always use needleless systems and aseptic technique when drawing and transferring blood. |

| |Replace the needleless connection device after blood draws to prevent infection. |

| |Use only 10 ml or larger barrel size syringes to draw blood from a central venous catheter to avoid too much |

| |pressure on catheter. Attaching Vacutainer® barrels directly onto a catheter, especially the PICC could cause |

| |increased pressure inside the catheter and damage the catheter. |

| |Keep the needleless connection device in place while drawing blood to avoid the possibility of air embolus while |

| |changing syringes. |

| |Prior to blood sampling, verify the identity of the resident by at least two means of identification. |

| |Do not obtain blood sample through an infusion administration set (IV tubing). |

| |Access implanted venous ports with a non-coring needle. Flush the line with saline and heparin before de-accessing|

| |the port. |

| |Flush the line with normal saline |

| |Collect waste blood |

| |Obtain lab samples |

| |Flush the line with normal saline |

| |Flush with 100 u/mL heparin before de-accessing the port. |

| |Use the pull-stop technique when obtaining blood samples from a central venous catheter. |

| |Consider how the use of the lumen and the type of lock may affect the laboratory values. For example, a heparin |

| |lock may affect coagulation studies; obtaining blood samples for therapeutic monitoring from the same lumen used |

| |to administer the drug may affect accuracy. |

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|Equipment and Supplies |3 pre-filled 10 ml syringes with 5 ml normal saline; |

| |1 pre-filled 10 ml syringe with 5 ml heparin (10 unit/ml) for open ended lines; |

| |1 or more sterile syringes (10 ml or larger barrel size); |

| |Alcohol wipes; |

| |Sterile end cap/injection device; |

| |Blood transfer kit (needleless); |

| |Vacutainer® tubes; and |

| |Non-sterile gloves. |

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|Helpful Tips When Drawing Blood |All central lines can be used to draw blood. When using a PICC line, at least a 4 FR size is recommended. |

| |To facilitate blood return, gently reposition the resident to a sitting or lying down position, or ask him/her to |

| |cough. If using a PICC line, you may also ask the resident to straighten his/her arm. |

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|Steps in the Procedure |Stop any infusions for 1-2 minutes prior to accessing the catheter. |

| |Assemble supplies. Remove any air bubbles from syringes. |

| |Perform hand antisepsis. Don non-sterile gloves. |

| |Attach primed saline or heparin syringe to new needleless access device (end cap, valve). Prime with 0.5 ml flush |

| |and place in clean area for use after blood draw. |

| |Leave needleless access device on end of catheter. Clean end of access device with alcohol wipe. |

| |Only use syringes to draw blood from catheter. Do not attach vacuum tube. |

| |Attach saline syringe to end of catheter and use push-pause flush method to infuse 5 ml saline. Stop flushing when|

| |there is 0.5 ml of saline in the syringe. |

| |With same saline syringe attached, withdraw 5 ml of blood (for waste) using pull-stop method. |

| |Disconnect syringe with blood waste from catheter (clamp catheter if necessary). |

| |Discard blood waste syringe in sharps container. Do not re-infuse blood into resident. |

| |Attach 10 ml (or larger) sterile empty syringe to access device. Withdraw necessary amount of blood for needed lab|

| |samples. This process may be repeated with as many sterile syringes as necessary to get needed amount of blood. |

| |Place filled syringes in clean area. |

| |Note: When obtaining cultures from central line, the line should not be flushed and blood waste should not be |

| |discarded prior to obtaining sample. |

| |Post blood draw, flush with minimum of 10 ml of normal saline using push-pause flush technique. |

| |New needleless connection device (end cap, valve) can be attached to catheter with saline flush or heparin flush. |

| |To place new needleless connection device, clamp or kink catheter, have resident hold his/her breath, remove old |

| |access device, and place new access device (screw into place). Allow resident to release breath. Unclamp catheter.|

| |Finish flushing with saline and/or heparin. |

| |Remove syringe and clamp (if necessary). |

| |Dispose of flush syringes in sharps container. |

| |Transfer blood sample into tubes to send to lab (see below). |

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|Steps in the Procedure (continued)|Transferring Blood Sample into Laboratory Tubes: |

| |Never use a needle to transfer blood. Use a needleless transfer device (according to manufacturer’s instructions).|

| |Transfer blood into tubes in a sequence according to lab protocol. Contact lab to see what sequence the tubes are |

| |to be filled. Some tubes have additives that could be transferred into other tubes through the transfer system and|

| |interfere with lab results. |

| |Label tubes with resident’s information (per lab requirements), date, time, and initials of person drawing blood. |

| |Place lab paperwork and tubes into lab biohazard transport bag. Send to lab. |

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|Documentation |The following information should be recorded in the resident’s medical record: |

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| |Date, time of specimen collection, type of tests. |

| |Site of collection. |

| |Condition of resident post blood draw. |

| |Laboratory results and notification of physician of results. |

| |Signature and title of person who is recording/reporting data. |

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|Reporting |Notify physician, supervisor, and oncoming shift of any problems or inability to get blood sample. |

| |Report other information in accordance with facility policy and professional standards of practice. |

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|References |

|MDS (CAAs) |Section I; Section O; (CAA 12; CAA 14) |

|Survey Tag Numbers |F328 |

| |See also INS 2011 Standard 57, Practice Criteria II G; INS 2008 flushing protocol |

|Related Documents |Guidelines for Preventing Intravenous Catheter-Related Infections (Infection Control) |

|Risk of Exposure |Blood–Body Fluids–Infectious Diseases |

|Procedure |Date:________________ By:__________________ |

|Revised |Date:________________ By:__________________ |

| |Date:________________ By:__________________ |

| |Date:________________ By:__________________ |

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[1] INS 2011 Standard 57, Practice Criteria II G

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